Major Changes for California Work Comp as of Jan 1, 2014

Major Changes for California Work Comp as of Jan 1, 2014

As anyone who bills for work comp in California knows, we have been using a modified set of CPT codes from 1999 for our billing since, well, 1999. This little gem is known as the "Official Medical Fee Schedule", or OMFS. Starting the middle of next week, we will be using a modified set of current CPT codes.

Only one new patient visit per injury will be allowed, regardless of how long it has been since you have seen the patient. This means if you last treat a patient in 2007, and they come back to you in 2014, it is coded as an established patient visit, NOT a new patient visit.

Sharon
Moderator

Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific
situation.

Here is some information that I sent to my chiropractors in California. Hope it helps someone that may be researching the changes

California Workers Compensation

Changes effective 01/01/2014

Additional edits effective 1/21/2014

The Table A fee schedule is no longer active. RBRVS fees have taken effect starting 1/1/2014.
If you would like to review California's new RBRVS-based fee regulations and fee schedules, go to the Dept. of Industrial Relations site at: http://www.dir.ca.gov/dwc/omfs9904.htm

Payments are reduced for multiple physical medicine codes billed on the same day, following these basic rules:
• Full payment is made on the highest valued practice expense code
• For subsequent codes: full payment is made for work & malpractice components, while 50% payment is made for PE component.
• In addition, there are caps on reimbursement.

From the Division of Workers Compensation (DWC):

> I would like to be treated by my personal chiropractor or acupuncturist. How does that work?

If your employer or your employer's insurer does not have a MPN, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. There is a form you can use called the notice of personal chiropractor or personal acupuncturist. After your claims administrator has initiated your treatment with another doctor during the first 30-day period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist.

> Are there limits on certain kinds of treatment?
Yes. If your date of injury is in 2004 or later, you are limited to a total of 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits, unless the claims administrator authorizes additional visits or you have recently had surgery and need postsurgical physical medicine.

> Does the 24 cap on chiropractic visits apply to all cases?
No. The 24 visit cap does not apply to injuries that occurred before Jan. 1, 2004. Also, the cap does not apply if your employer authorizes additional visits in writing. Additionally, the cap does not apply to visits for certain postsurgical physical medicine and rehabilitation services.

> If your primary treating physician is a chiropractor, what happens after the injured worker has had 24 chiropractic visits?
If your injury occurred on or after Jan. 1, 2004, your chiropractor can no longer act as your primary treating physician (PTP) once you have reached the 24-visit cap. You will have to designate a new, non-chiropractic PTP once the claims administrator notifies you that you have reached the cap.

> How has the predesignation process changed?
Before SB 863, in order to predesignate your personal physician, you had to meet certain qualifications. SB 863 makes predesignating available to more employees by changing the requirement that “your employer offers group health” to “you have health care insurance for injuries or illnesses that are not work related.” During the rulemaking process, DWC will develop a new optional form that may be used to predesignate a personal physician.

I found a company called Daisybill which was heaven sent in figuring out which codes were still valid, which weren't and how much to charge for each code.

Daisybill.com has an RBRVS calculator that you can enter in the cpt code and it will tell you if the code is valid and pricing for each code.
I believe the calculator is free or it has a free trial. I enrolled with daisybill to send some work comp claims through their electronic work comp system ($2.50 per claim) so the calculator is free to billers that utilize the system.

Worth looking into if someone is struggling with which codes are deleted and which are now valid.

**I am in no way affiliated with Daisybill.com
This is just something I came across, researched and found to be a really good company with useful components in relation to my business.